Differential Diagnosis for Chronic Chest Pain

The following differential diagnosis is organized into categories to help guide the thought process:

• Single Most Likely Diagnosis

  • Gastroesophageal reflux disease (GERD): This is a common condition that can cause chronic chest pain, especially if the pain is worsened by eating or lying down. The pain is often described as a burning sensation in the chest.

• Other Likely Diagnoses

  • Coronary artery disease: This condition can cause chronic chest pain, especially in patients with risk factors such as high blood pressure, high cholesterol, or a family history of heart disease. The pain is often described as a squeezing or pressure sensation in the chest.
  • Musculoskeletal pain: This can be caused by strain or injury to the muscles or joints in the chest wall. The pain is often sharp and localized to a specific area.
  • Chronic obstructive pulmonary disease (COPD): This condition can cause chronic chest pain, especially in patients with a history of smoking or exposure to lung irritants. The pain is often worsened by deep breathing or coughing.
  • Anxiety or panic disorder: These conditions can cause chronic chest pain, especially in patients with a history of anxiety or panic attacks. The pain is often described as a sharp or stabbing sensation in the chest.

• Do Not Miss Diagnoses

  • Acute coronary syndrome: This is a life-threatening condition that requires immediate medical attention. The pain is often described as a severe, crushing sensation in the chest.
  • Pulmonary embolism: This is a life-threatening condition that requires immediate medical attention. The pain is often described as a sharp, stabbing sensation in the chest that worsens with deep breathing.
  • Aortic dissection: This is a life-threatening condition that requires immediate medical attention. The pain is often described as a severe, tearing sensation in the chest.
  • Esophageal rupture: This is a life-threatening condition that requires immediate medical attention. The pain is often described as a severe, sharp sensation in the chest that worsens with swallowing.

• Rare Diagnoses

  • Pericarditis: This is an inflammation of the sac surrounding the heart, which can cause chronic chest pain. The pain is often described as a sharp, stabbing sensation in the chest that worsens with deep breathing.
  • Pneumothorax: This is a collapse of the lung, which can cause chronic chest pain. The pain is often described as a sharp, stabbing sensation in the chest that worsens with deep breathing.
  • Mediastinitis: This is an inflammation of the tissues in the mediastinum, which can cause chronic chest pain. The pain is often described as a sharp, stabbing sensation in the chest that worsens with deep breathing.